The Vermont Association of Hospitals and Health Systems, which has been working with the University of Vermont Medical Center for almost two years to oppose the project, joined Northwestern Medical Center in St. Albans in a letter to regulators Tuesday.
Investors in the proposed independent surgical center in Colchester asked on June 2 for a meeting with new members of the Green Mountain Care Board before the new members make a decision on whether to approve the project.
Lawyers for investors in the surgical center say Kevin Mullin, the new board chair, and Maureen Usifer, the new board member, should be able to have a direct question-and-answer session with the investors.
The case has been going on for nearly two years in front of the board, which regulates hospital budgets, insurance prices and proposed capital investments, including the proposed Green Mountain Surgery Center, in an application process for what’s called a certificate of need.
For more than five months, the five-member board was functioning with just three members because Al Gobeille, the former chair, left to become the secretary of the Agency of Human Services and Betty Rambur, a former member, moved away.
In May, a month after the three members held two days of hearings on the project, the only three people sitting on the board wrote that they could not legally make a decision because they were split. Case law requires three votes, they wrote, and that meant the three members at the time needed to decide unanimously.
The board wrote at the time that it would wait for new board members to take their seats and read through the record before making a decision. The board did not say there would be an additional hearing on the matter with all five members.
Now, the investors say the board should meet with Amy Cooper, the lead investor in the surgical center, so she can answer members’ questions. Cooper said that’s more effective than simply reading the record or asking questions in writing.
“We want to give the new board members the opportunity to ask questions in person and have follow-up questions,” Cooper said in an interview. “You can’t achieve the same level of clarity if you’re just emailing back written responses.”
The Vermont Association of Hospitals and Health Systems and Northwestern Medical Center in St. Albans say investors should not get additional face time.
“The record regarding the application, compiled over almost two years, is complete,” the hospital association and the medical center wrote in a joint letter to the Green Mountain Care Board.
“There have been two in-person public hearings to discuss the application which were both transcribed and videotaped,” the letter said. “There has been ample opportunity to submit public comment. … Should the new members have questions, they can easily be answered in writing.”
Cooper argued: “I think that this is a unique circumstance where the board is adding two new members who did not have the benefit of hearing from the applicant in person, so we’d just like to afford the new board members the opportunity to hear our case for the surgery center in person.”
The Green Mountain Surgery Center has support from the state’s three major insurers — Blue Cross Blue Shield of Vermont, MVP Health Care and Cigna. The Vermont Education Health Initiative — the health care plan for teachers — also supports the surgical center.
The Office of the Health Care Advocate, which participated in the hearings in April, submitted legal arguments to the Green Mountain Care Board in support of the project. The office serves as the official public advocate in certificate of need cases.
“We believe that this facility, with the conditions we suggest, will be beneficial to
consumers and therefore to the health care system as a whole,” the advocate wrote, because the investors have said the surgical center “will give patients and doctors an affordable, efficient, high quality option for a limited set of medical procedures.”
“(The investors have) stated that Vermonters will have access to the facility regardless of their insurance status and that the GMSC will implement a financial assistance policy that adheres to federal requirements for nonprofit hospitals,” the advocate wrote. “We appreciate these assurances from (investors) and ask the Board to ensure that they are realized.”
Opponents say the new facility isn’t needed because the UVM Medical Center has unused surgical capacity. They also argue the center would draw away revenue that hospitals rely on to support the more advanced services and facilities they offer.
The Office of the Health Care Advocate said that possibility is not reason enough to reject it. “We do not believe that the possible negative impact on hospitals’ revenue in this case negates the need for improvement and innovation in other parts of our health care system,” the advocate wrote. “We are confident that the hospitals have the ability and financial flexibility to adapt to changes in the system including this relatively small project.”
A lawyer for the board says it has until early August to approve or deny the certificate of need.
